The scientific basis of cardiopulmonary and cerebral resuscitation

Abstract

A survey is given on the scientific background of cardiopulmonary-cerebral resuscitation, which supposedly will be the basis of all clinical practice in this field. Haemodynamic, respiratory, acid-base, and cerebral problems are discussed in detail. As for haemodynamics, the pathomechanisms of the conventional "heart pump" and the "thoracic pump" as background of the "New CPR" are compared, the flow being generated by a direct compression of the heart in the former and by a phasic increase of the intrathoracic pressure in the latter case. Combined effects of both modalities mainly depending on the geometry of the thoracic cage, are usually seen. Improvement of flow by modifying the criteria of thorax compression (duration, frequency, strength) is then discussed, and new methods or CPR as e.g. simultaneous/synchronous compression/respiration, Vest-CPR, MAST-CPR, abdominal compression and Cough-CPR are mentioned and their mechanisms explained. Finally, open cardiac massage is no doubt superior to all the other indirect and closed methods of cardiac resuscitation. Defibrillators and heart-lung "thumpers" are then described, mentioning the improvements in respect of automatic and semi-automatic defibrillation and the progress made by developing flexible and individually adaptable types of "thumpers". On assessing the sympathicomimetic drugs, it is evident that epinephrine is the method of choice in the acute phase of resuscitation; the pure beta-adrenergics isoprenaline and orciprenaline are not used any more, whereas the alpha-mimetics, although acutely effective similar to epinephrine, cannot produce positive long-term effects; the combination of dobutamine and dopamine seems to be ideal for establishing stable haemodynamic situations following a successful acute reanimation procedure.(ABSTRACT TRUNCATED AT 250 WORDS)